Wednesday, October 20, 2010

The Virgin Gut

By Ann Calandro, BSN, RNC, IBCLC

Photo courtesy of peaceful parenting mom, Michelle.

I have been a mother for 26 years. When my first daughter was born, I knew little about breastfeeding except that I wanted to "try" to be successful. I knew it was best. I planned on nursing for six weeks to give her a good start.

She was born in Riverview Hospital in New Jersey in 1976. I waited impatiently to be allowed to see her every four hours for nursing. She arrived in my room with a little bottle of glucose water on board in her crib. The nurses encouraged me to fill her up with sugar water after each nursing, because my milk was not enough. Between nursings, she received formula in the nursery, because she was hungry and the hospital would only bring her out at certain times. During visiting hours, no babies came out.

Even though I am a nurse, I did not know enough about breastfeeding to object to this practice. My baby became jaundiced (which I know now is prolonged by giving water), and we stayed in the hospital for five long days. This was after a totally unmedicated birth. When we went home, I was gifted with cases of water and formula to feed her ad lib. Fortunately, my pediatrician advised me not to give either to her if I wanted to be successful with breastfeeding. Good advice. I let it all expire in my kitchen pantry and later threw it away. (Thank you, Dr. David Ohmart, wherever you are!)

After she was a few months old, I was talking to another breastfeeding mother at a La Leche League meeting. She proudly stated that her son still had his "virgin gut." I asked her what that meant. She said he had never had anything in his stomach besides breast milk. She said that because of that, he would be healthier and less likely to have allergies. I was confused and a little doubtful, but her words stuck with me.

Since my baby had received lots in her stomach besides breast milk, her little gut was not virginal. What did this mean? Had the hospital nurses inadvertently done some kind of damage to her? Had I? What was going on inside my little girl? I wasn't sure, but just in case my friend was right, I made sure that my next three children had "virgin guts" until starting solid foods around 6 months of age.

In the Beginning

Many babies who are breastfed begin their lives in hospitals that routinely supplement with artificial formulas. Sometimes babies are given artificial milk for medical reasons such as low blood sugars or because their mother is very ill. More often, they are given artificial milk for non-medical reasons, because nurses offer it to keep them quiet, or because mothers are concerned that their babies are hungry because they are nursing so often. Some mothers want to sleep and leave their baby in the nursery all night, so they ask the nurses to feed the baby formula. Innocent enough reasons – and common. So common, in fact, that very few babies leave the hospital with their virginal guts. But what happens when breast milk is not the only food in that little gut? The truth is very interesting and also very scary. Turns out, my friend was right.

When babies are born, they have sterile gastrointestinal tracts. If babies are exclusively breastfed, they develop a natural healthy gut flora. (When I speak of the gut, I mean Baby's insides where the food goes until it hits the diaper.) This means that the major flora in breastfed babies has reduced numbers of bad types of bacteria and increased numbers of good bacteria. Formula-fed babies have increased numbers of bad bacteria, leaving them at more risk for illness.

Breastfed babies who are fed formula in the first week of life have a delay in the development of a healthy gut flora. Their gut flora is more like formula-fed infants. This description appears in Lactation: Physiology, Nutrition, and Breast-Feeding by Margaret C. Neville and Marianne R. Neifert:

The effect of breastfeeding on the infants' gut flora was abolished by cow's milk supplementation. However, in the same study, infants fed on breast milk with supplementation of humanized cow's milk established a low stool pH and a dominant flora of bifidobacteria (the good stuff) with a two- to six-week delay. At present, it is not known to what extent supplementation can be practiced without destroying the characteristic intestinal flora of the breast-fed baby.

Colostrum helps to build a mucosal barrier, which protects babies against infection and is anti-inflammatory. Breastmilk is living protection against all kinds of germs. Mother Nature sure knew what she was doing.

It takes many weeks for the baby's gut to close up the leaks in order to seal off germs and to develop the ability to shut out allergenic proteins. If given formula in the early weeks, this closing up is delayed and the risk of allergies and illness increases. The type of bacteria in the gut becomes less protective. In other words, Baby is more at risk for illness.

Just one bottle of formula - given for any reason - can sensitize babies who may be allergic to cow's milk protein or soy protein. This is especially important to know if you have allergies in your family. Some studies have indicated that giving cow's milk formulas early may also increase the risk of some children for developing insulin dependent diabetes.

The Real Risks

A breastfeeding mother I worked with recently found out that offering formula early can cause severe problems for some babies. She found this out the hard way. Her baby had early sucking problems and was given formula for a few days in the hospital. This mom worked hard to establish her breastfeeding and soon was successful. Things were going very well until she decided to go shopping one day and leave formula behind for her husband to feed her 6-week-old son. She was not concerned because he had already had formula and shown no adverse affects.

When her husband fed her son, the baby began having severe reactions and was rushed to the hospital. Hospital staff did not think that the problems were related to the formula. This little guy was subjected to thousands of dollars in tests – all negative. He went home exclusively breastfeeding. A few weeks later when his daddy gave him another bottle of formula, he turned blue, almost stopped breathing and was once again rushed to the hospital. It was determined at last that he was allergic to formula. His allergies began with the early formula sensitization in the hospital nursery. Needless to say, he never got formula again. Formula is not so innocent for some babies.

Alternatives to Formula

Sometimes the addition of artificial formulas to infant diets is unavoidable for a variety of reasons. If this is the case, there is very little that can be done to remedy the situation and save the virginal gut. Some hospitals provide banked human milk for babies that must be given supplemental food until mother's milk is available. The majority of hospitals do not. Recent studies have shown that giving hydrolyzed formula to a baby born in a family with a history of allergies may be the best alternative if formula must be given.

Having knowledge of the importance of what is normal for newborns inside may help some mothers in making a decision about whether or not to supplement their babies for convenience in the early weeks. Very few mothers know how totally different babies are on the inside when artificial food is added to their diets. Some mothers add the formula in the hopes that their babies will sleep longer at night [a mythological practice that has been shown to be no more effective than 'stuffing' baby up on human milk]. Knowing that only one formula bottle a day can totally change the protective environment of their baby's gastrointestinal tract may give them pause to reconsider before instituting this practice.

The case for the virgin gut is a valid one. There is much research to support avoiding supplementation if at all possible. A huge increase in diarrheal diseases occurs in babies who do not have optimal "intestinal fortitude," which is only possible with guts that have never been exposed to infant formula.

To preserve your baby's virgin gut, be proactive:

* Let your pediatrician know that you do not want the baby to have any formula. Ask him or her to write it as an order in your baby's chart.

* If the baby has a medical need for more milk, express some colostrum to feed to the baby with a cup or spoon.

* Place a small card in your baby's crib, and/or dress baby in a onesie, notifying staff that you do not want your baby to have any formula, and if there is a medical need, staff must get written permission from you before it is given, so that alternatives can be explored.

If Baby has lost his virginal gut don't despair. Exclusive breastfeeding for many weeks will hopefully restore the gut to a normal healthy state.

22 comments:

when Adriana was born at 35 weeks gest. I had a great labor & delivery nurse she & my ob made sure since she was stable 8 & 9 apgar that she stayed skin to skin for an hour learning to nurse & bonding with me. Its covenants policy any baby under 36 weeks transin the NICU. The nicu nurse was not happy & pushed formula to keep her out of the nicu after trans she kept saying if her blood sugar is low she will stay. My dr & nurse asked her to leave for the hr & how much colost equalls an oz of formula 20 drops she had more than that her bs was normal. My husband went to the nicu with her for her trans it was only he just her temp was a little low. We never let her go to the nursery without one of us. God bless my labor nurse Steph & Dr Hines for saving my baby girls virgin gutt.

My infant son is EBF, but I sometimes wonder if he was given formula without my knowledge when we were in the hospital. The pediatrician who looked at him that day (not our usual one)told me that he was a biter. I already knew that because he always bit down on my nipple when he first latched on. I wish I had asked her how she knew that. I don't know if she saw him biting the nipple of a bottle or if she stuck her finger in his mouth.

So interesting! My last four babies have all had virgin guts until they started solids. My littlest one is 8 months old and his gut is still virginal! I love the validation that we're doing the right thing by avoiding formula and solids. :)

So does this apply only to formula? Or is the apple juice that my son'd ped prescribed for constipation (which wasn't even that, but infrequent bowel movements) detrimental to him also? What about the Milicon (sp?) gas drops I give him about once a day? Should he be ingesting NOTHING but breast-milk, and if so, how can I deal with persistent gas that won't go away even with changes in my diet?He was 5 weeks preemie, and is now 7 weeks old. He had formula in the hospital, as well as some for about a week at home while I pumped and dumped due to antibiotics and pain meds for a uterine infection. He's been EBfed for about 4 weeks now, except for the apple juice ans gas drops.

I have the same question as Debi... does this only apply to formula? My 2 month old received oral vitamin K and has received probiotics. What about the oral vitamins, gripe water, and nystatin that our older daughter got as a baby?

And Debi, we have gas issues here, but from what I've heard, Mylicon is basically worthless. Our ped suggested gripe water, chamomile tea, or probiotics. We have her on Culterelle now and we want to try Reuteri.

I was really annoyed after I had my son (my second child) because he was perfectly healthy after a natural delivery, and yet he was taken away from me for 3 hours after I delivered, AND when they brought him to me (finally!) they had given him formula because "he was so big (9 lbs)" and they were worried that he wouldn't get enough from me. That really made me mad. I was so shocked after a very intense labor and delivery, that I forgot to mention that I didn't want them to give him anything. If I had it to do over...

My son, Wyatt, was born at 38 weeks after an induced labor due to pre-eclampsia. After 34 hours of labor and a ton of mag sulfate I was exhausted and out of it. They took him to the nursery to do his check and assured me he would be back in an hour. I did not get him back for 13 hours. They observed him and gave him broad spectrum antibiotics due to his O2 levels dipping and my long labor. The pedi came to my room and I cried and begged her not to give him a bottle. They did it anyway, tiwce. After that he was exclusively breastfed. At 3 weeks old I started noticing blood in his sool. After strict diet changes and allergy testing, it still persisted. At 5 1/2 months he ended up in the hospital anemic and having severe colitis. He had a colonoscopy and a bone marrow biopsy. I was told to stop breastfeeding immediately and he was placed on a hydrolyzed formula until he was 15 months old. The allergist believes it was a protein sensitivity. He is 4 now and has no allergies. I believe that his natural gut flora was ruined by the assualt of the formula and antibiotics and the fact that he was early. For the record, I am also a nurse at a large urban hospital. My second baby was born without any intervention, 8 minutes after I arrived at the hospital and is still breastfed at 15 months old. She has no allergies and kept her virgin gut until 6 months when she started some solids.

I'm always interested in virgin gut, because my son was born at 28 weeks due to pre-e. He never received a bottle of straight formula, but human milk fortifier/formula were mixed in with his breastmilk to give him necessary extra calories (at two pounds, he needed them!). At two, he's very healthy with no allergy problems that we know of, and I hope that we stay that way, although I know in our case it was a necessary risk to take. I'm due with his little brother in February, and hoping against hope that we'll get to have just breastmilk in his little tummy until he's ready for solid food!

Is there anything that can be done to 'fix' a non-virgin gut if the baby has to go on antibiotics? I don't want to give him anything I don't have to give him but it can't be good to have all those good bacteria killed off.

Just want to put this out there...if you birth in a hospital, you can insist on your baby never being out of your sight. You wouldn't let the pediatrician take them in the back and do stuff to them without you there, so why let hospital staff do that? We are the only voice and advocate our newborns have. It's our responsibility to stay with them. Hospital staff can't do anything against your wishes if you are standing right there watching over. It may annoy some of the nurses or doctors, but really, who cares? It's more important to be there for your baby.

My baby was taken to the nursery due to being hypoglycemic, temp instability and tachypnea (rapid breathing). I was very set on him being EBF with no supplementation. I told them that I wanted to go with him but because I lost a lot of blood after he was born they'd have to find a wheel chair. 20 minutes later they still hadn't come to get me and so I walked over there. Much to my dismay there was a nurse FORCE feeding him formula. He was sputtering and gagging on it. I was so upset, especially since I had JUST fed him right before they took him over there. Luckily he only took 5 mls but I was still very upset. Fast forward 2 months later and he was still EBF (no supplementation since that one time in the hospital), then he started having bloody stools. I did and elimination diet and found he was allergic to what? DAIRY. The same crap they forced down his throat at just 3 hours old. Hopefully he outgrows it but we wont know for a while if he does or not. But who know if he would have developed this allergy or not if he had not been exposed to dairy in the formula they forced on him.

Kelley - I didn't think that was true (in general, your situation may have been unique), that a premie needs more calories than his Mom's milk provides. I pumped for my daughter who was born at 35 weeks. When she passed away I donated my milk to a milk bank, and they made an exception to their minimum donation requirement because it was "premie milk". I read that milk from a mother who has birthed prematurely has more calories naturally, simply because our bodies know that baby was born before they could properly plump up, and they need the extra calories. I don't have a reference handy, but maybe you could look into it more before your next baby is born. Good luck!

The virgin gut can be invaded but brought back to virginal state in 2 weeks. If a baby has one bottle of formula & has no more & 2 weeks goes by..the gut is completely clean again. We are built to heal ourselves quickly & all of the coating of proper bacteria can be redone. I appreciate what the author is saying, I have always thought the same thing, but the latest research shows in 2 weeks it can be rebuilt, its not changed forever, our bodies would never be fixable as adults if we weren't renewing ourselves constantly, esp. in infancy.

I don't understand why babies are taken away from their mothers. When my baby had to have the general tests done, I asked for them to be done in my room or I went with them. Other than that, my baby slept in my room in her bassinet. Is in normal in America for babies to be taken to a nursery even if they're perfectly healthy?

MamaKoo, it's becoming less common. But hospitals have large nurseries that are largely unused. But I have met several parents that tell me to have the baby taken to the nursery over night and get some sleep... I never even let mine sleep in the bassinet. I read that the American hospitals still have the nurseries available because it has to do with funding and space. Dumb... really dumb. It used to be that the babies were swept away to a viewing area. And the moms only got to hold them every few hours. I remember my little sister being in an incubator a few hours after she was born, in a totally different room... She was full term, healthy, no reason for an incubator. That's just the way it was.

It's really sad when you think about it. It makes my heart break hearing about these stories and they're from women who actually feel that it's right protecting thier babies from such things. Imagine what it would be like to be a baby with negligent parents. Already life is such a struggle at such a tender age. Not one baby deserves it.

My daughter was never taken from my room but she didn't have any "issues" like my son did. I was very clear on wanting to stay with him at all times and the hospital (well the nurses) failed. If I could go back I would have just walked over with them as they took him over there. Or made them wait to take him until they got me a wheel chair since it wasn't anything emergent.

I have to say coming from NZ where we are encouraged by hospital midwives as well as posters all over the maternity wards to breastfeed (I'm not saying 100% of the mothers do nor am I saying that all do exclusively or for longer than 6 months... but) that I find it appalling that anyone would be able to feed or administer something to your child without your consent, in fact I find it unusual that you would have to state that you don't want somebody to feed your child -could somebody please enlighten me about hospital procedures in the US? In NZ your baby (unless they are prem or ICU) is always next to or in the mothers bed while at the hospital.

I don't get it either, Anonymous Feb 21 2012. Do they charge the insurance companies per bottle of formula? Or the use of the nursery? I don't understand why they take babies away from their mothers at all. When my daughter was born by c-section, she was placed straight on my chest with the cord still attached to the placenta. We had delayed clamping. My daughter left my chest twice in 16 hours before I was discharged. Once, as I was transferred from the table to the bed; and once when I got out of bed 12 hours later to remove my catheter. Even then, my baby stayed in my bed whilst I was in the adjoining bathroom for about 2/3 minutes and then I returned where she stayed with me all night and we left in the morning. No one asked to take her away, (I was on the defensive in case someone did try and they tried to feed her formula or sugar water or something) but not once did anyone try. They had no reason to. There was two options, with me, or in the little cot next to my bed, but never away from me. US hospitals get far to hands on with babies and birth; I don't get it. (I realise the irony, if I had the option, I would have birthed at home, but no such luck.)